Big toe, Big implications

It is football season. With all due respect to baseball, hockey, and basketball…it is football season. Growing up in the Pittsburgh area, football was king, and it wasn’t even close. As young ones, we were educated as equally on America’s Mt. Rushmore as we were on the Steelers’ Mt. Rushmore. The latter consisted of Joe Greene, Franco Harris, Terry Bradshaw, and Jack Lambert (I could pick only 4). Any Pittsburgher could tell you the fabled injury that ended Jack Lambert’s career: turf toe. Turf toe! As children we couldn’t comprehend how a toe could sideline the fierce and toothless Jack Lambert. This is the answer to the great mystery.

Before we dive into turf toe, let’s talk about how the big toe is important for all of us, even those that have never had turf toe and do not play a field sport like football.

Walking, running, hiking, dancing, yoga, crossfit: if you participate in any of these activities, proper movement of the big toe is important. The hallux (1st toe, great toe, big toe) needs 60-100˚ of extension. You might be wondering how a person can lose range of motion in their big toe. There are medical conditions, such as hallux rigidus and hallux limitus, but more often than not it’s from soft tissue tension around the joint. Flexor hallucis brevis and the plantar fascia are two notorious structures known for limiting the great toe.1 Check out the video below to learn how to loosen up this tension.

An inability to move our hallux can cause problems elsewhere, too. Plantar fasciitis, Achilles tendinosis, shin splints, knee pain, hip, and low back pain: ever experience any of those symptoms or pains? Issues with the hallux can lead to some of these conditions. 

First of all, what is turf toe? Turf toe is a hyperextension injury of the great toe, causing a sprain to the metatarsophalangeal joint and damage to the joint capsule.2 This condition typically causes pain, swelling, and stiffness around that MTP joint. Walk into a trainer’s room before a game, and you’ll find plenty of people getting their big toes taped to prevent some of the pain associated with turf toe. While very common to football, this injury can occur in other sports and even in the sports of weightlifting or crossfit, for those who practice the split jerk.

But is this an issue just at the great toe joint? The literature states that folks with functionally flat feet have increased range of motion at their MTP joints.3 I say functionally flat feet because many people with flat feet really just have feet that are weak and lazy. So we could assume that increased range of motion in a joint could lead to a hyperextension injury seen in turf toe. What about the ankle? If we’re lacking ankle dorsiflexion this leads to an early heel lift and amplifies the stress on the hallux MTP.1 If we think about those missing ankle range of motion, they oftentimes spin their feet out, leading to a less than ideal stress on that 1st MTP joint.

So what can we do to prehab or rehab turf toe. If you’re in a high school, college, or professional sport, talk to your ATC about how they can help with taping and other approaches. If possible, wear a shoe that has a stiff sole. This stiffness will limit the hyperextension placed on the 1st MTP.

Here are a few additional tools to help improve range of motion in that hallux. 

Stabilize/Strengthen the big toe and feet with these simple approaches. 

1.       Michaud, T. C. (2011). Human locomotion: The conservative management of gait-related disorders. Newton, MA: Newton Biomechanics. 29-30.

2.       Chinn L, Hertel J.. Rehabilitation of ankle and foot injuries in athletes. Clin Sports Med. 2010;29:157-167.

3.       Nawoczenski D, Houck J, Barnes E. Functional hallux limitus in the pronated foot: challenge to current theory, J Orthop Sports Phys Ther 2003;33: A-12.